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J Neurol Neurosurg Psychiatry 2007;78:457-460 doi:10.1136/jnnp.2006.098228
  • Paper

Oops! Resolving social dilemmas in frontotemporal dementia

  1. Paul J Eslinger1,
  2. Peachie Moore2,
  3. Vanessa Troiani2,
  4. Shweta Antani2,
  5. Katy Cross2,
  6. Shaleigh Kwok2,
  7. Murray Grossman2
  1. 1Departments of Neurology, Radiology, and Neural and Behavioral Sciences, College of Medicine, Pennsylvania State University, The Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  2. 2Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to:
 Paul J Eslinger
 Department of Neurology–H037, Penn State Hershey Medical Center, PO Box 850, Hershey, PA 17033-0850, USA; peslinger{at}psu.edu
  • Received 18 May 2006
  • Accepted 22 September 2006
  • Revised 20 September 2006
  • Published Online First 29 September 2006

Abstract

Objectives: Our social cognition model posits that social knowledge and executive resources guide interpersonal decision making. We investigated this model by examining the resolution of standardised social dilemmas in patients with a social and executive disorder (SOC/EXEC) caused by frontotemporal dementia (FTD).

Methods: Patients with SOC/EXEC (n = 12) and those with progressive aphasia (APH, n = 14) completed measures requiring resolution of social dilemmas (Guilford’s Cartoon Predictions Test), social cognition (theory of mind false belief vignettes and a behavioural rating measure of empathy) and executive measures of cognitive flexibility (Visual Verbal Test). Regression analysis related judgments of social dilemmas to cortical volume using voxel based morphometry of high resolution structural MRI.

Results: Patients with SOC/EXEC were impaired in judgments of social dilemmas as well as theory of mind, self-awareness of empathy and cognitive flexibility. Patients with APH were much less impaired in the social and cognitive measures. There were strong correlations among social dilemma, theory of mind and mental flexibility measures in patients with SOC/EXEC, and stepwise regression showed that mental flexibility was most predictive of social dilemma judgments. Social dilemma impairments in the SOC/EXEC sample correlated with cortical atrophy in the orbital frontal, superior temporal, visual association and posterior cingulate regions of the right hemisphere.

Conclusions: Deficits in patients with SOC/EXEC in resolving social dilemmas are related to depleted executive resources and social knowledge that appear to arise from disease that interrupts a right frontal–temporal neural network crucial for mediating social cognition.

Footnotes

  • Published online first 29 September 2006

  • Competing interests: None.

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